/ en Thu, 01 May 2025 22:15:19 -0500 Fri, 21 May 21 13:52:15 -0500 /position-paper/2021-05-21-aha-shares-workforce-policy-priorities-senate-help-committee <p>AHA urges the Senate Committee on Health, Education, Labor and Pensions to prioritize certain actions and programs that support the nation鈥檚 health care workforce needs in the wake of the COVID-19 pandemic and into the future. </p> Fri, 21 May 2021 13:52:15 -0500 Position Paper /position-paper/2021-05-10-examination-new-theories-price-effects-cross-market-hospital-mergers <div class="container"> <div class="row"> <div class="col-md-8"> <p>Traditionally, mergers that involve combinations of hospitals in different markets have not raised concerns under the competitive effects framework of the Horizontal Merger Guidelines, but the FTC appears to be contemplating an expansion of antitrust scrutiny beyond that called for by the Guidelines.<sup><a href="#fn2">2</a></sup> Under the Guidelines framework, competitive effects are based substantially on the substitutability of hospitals <em>within</em> a properly defined geographic market. The new enforcement approach would, however, involve transactions that cross <em>between</em> separate markets, and this is likely to be an area of particular interest to hospital systems.</p> <p>The FTC鈥檚 search for a new economic theory for these 鈥渃ross-market鈥� transactions draws from an emerging body of economic literature, including a recent working paper by former FTC economist, Leemore Dafny and two coauthors, Kate Ho and Robin Lee (鈥淒H&L鈥�).<sup><a href="#fn3">3</a></sup> DH&L propose a theory for evaluating whether and under what circumstances cross-market mergers might have anticompetitive effects. Based on empirical tests of their theory, DH&L find price increases of 6% to 10% attributable to certain cross-market hospital mergers. <strong>Underlying the theory and empirical results, however, are some questionable assumptions that appear to limit their applicability and validity.</strong></p> <h2>The New Theory and Empirical Analysis of Cross-Market Hospital Mergers</h2> <p>DH&L propose a theory with two separate means by which cross-market hospital mergers could create market power: a 鈥淐ommon Customer鈥� effect and a 鈥淐ommon Insurer鈥� effect. The Common Customer effect, which DH&L imply is the more important of the two, arises as a result of employers that either have work sites in more than one geographic area or a workforce that resides in more than one area and commutes to a common work site.<sup><a href="#fn4">4</a></sup> DH&L hypothesize that in the presence of common customers, a hospital merger can enable the system to raise its prices above competitive levels even when the merged entities do not compete for patients.<sup><a href="#fn5">5</a></sup> This phenomenon arises insofar as common customers receive greater incremental value from a network that includes the merged hospitals together than from the sum of the value of networks that include them individually. Separately, DH&L hypothesize that merging hospitals in different markets that contract with a common insurer may also be able to increase price. They note, however, that the Common Insurer effect may not necessarily be anticompetitive and that it is not as significant a determinant of cross-market effects as the Common Customer effect.<sup><a href="#fn6">6</a></sup></p> <p>DH&L鈥檚 analysis intends to separate the effect of cross-market mergers attributable to lessening competition from effects attributable to other causes. DH&L attempt to isolate competition-related price changes by estimating post-merger price changes for systems that acquire hospitals in an 鈥渁djacent鈥� market and those that acquire hospitals in 鈥渘on-adjacent鈥� markets, comparing both to prices of hospitals unaffected by transactions. DH&L argue that effects that appear in non-adjacent markets are unrelated to competition, but changes in adjacent markets have roots in incremental hospital market power.<sup><a href="#fn7">7</a></sup> Their analysis finds post-merger price increases of 6% to 10% for adjacent market hospitals relative to unaffected hospitals and no price increases for non-adjacent market hospitals relative to unaffected hospitals.<sup><a href="#fn8">8</a></sup></p> <p>DH&L note that the same cross-market effects that span different geographic markets may also span different product markets or sets of services offered by providers.<sup><a href="#fn9">9</a></sup> The courts have shown skepticism toward cross-product market arguments, however. The Ninth Circuit in <em>FTC v. St. Luke鈥檚</em> overturned the district court鈥檚 ruling that St. Luke鈥檚 market power in physician services gave it market power in ancillary services.<sup><a href="#fn10">10</a></sup> Absent a finding of market power in ancillary services, the Ninth Circuit reasoned, St. Luke鈥檚 could not harm competition in that market. The logical extension for geographic markets is that a hospital system that does not possess market power in an antitrust geographic market cannot harm competition in that market.</p> <h2>Serious Questions about the Theory and Estimation Process</h2> <p>Serious questions arise regarding both DH&L鈥檚 model and their empirical analysis. One issue is whether their <strong>model confuses key considerations in geographic market definition.</strong> Another involves <strong>the absence of considering the means by which health plans could avoid attempted cross-market price increases.</strong> In addition, the <strong>data used to estimate the model do not include actual prices and are highly aggregated thus potentially obscuring important differences among various payors.</strong> The empirical analysis also appears <strong>not to adequately distinguish effects related to changes in competition from those that are not.</strong></p> <h2>Geographic Market Too Restrictively Defined</h2> <p>According to DH&L鈥檚 theory, the Common Customer effect may arise when employers have workers commuting from one geographic market to another. Such commuting patterns likely blur the boundaries of the areas that DH&L characterize as adjacent geographic markets, especially since DH&L define within-market transactions to include only hospitals within a 30-minute drive time of each other.<sup><a href="#fn11">11</a></sup> In healthcare mergers, a geographic market is typically defined by the boundary of the area to which patients would be willing to travel for services in the event of a small but significant price increase.</p> <p>Under the geographic market approach laid out in the Guidelines, if all hospitals in area A increase their prices and enough commuters switch from using hospitals in area A to hospitals in area B, the hospitals in both areas combined rather than those in area A alone would constitute a properly defined geographic market. If so, the cross-market effects that DH&L ascribe to the presence of common customers, may be attributable to geographic markets that are too narrowly defined. With narrowly defined geographic areas, the 鈥渕arkets鈥� that DH&L consider to be adjacent could actually be part of a single and broader geographic market and the pricing effects that DH&L attribute to cross-market effects may be due to within-market effects. The narrow, 30-minute drive time geographic area that DH&L use for within-market transactions raises the possibility that their adjacent markets are defined too restrictively.</p> <h2>Increase in Value Will Not Harm Competition</h2> <p>The Common Customers framework can also be evaluated by ignoring the patients consuming hospital services and focusing on employers as the common customers who arrange options for their employees to receive hospital services. From that perspective, it is easier to discern the incremental value of a hospital system over its component parts. The increased value of a system is a necessary element for DH&L to reach their conclusions, <strong>but the incremental value can be driven by efficiencies that benefit customers.</strong> Multi-hospital systems bring value to employers or insurers because they reduce transaction costs and possibly increase quality over what could be offered by their hospitals individually. Transaction costs related to negotiating contracts, monitoring consistency of service, and administering claims are reduced through centralization. Likewise, quality can be improved by standardizing and monitoring clinical processes in a manner than cannot be done as readily across individual hospitals. <strong>The increase in value from a system is consistent with DH&L鈥檚 theory, and it changes the system鈥檚 relative bargaining power, but it does not create harm to competition.<sup><a href="#fn12">12</a></sup> If these types of system efficiencies are more likely to be present and to be of value to a common customer when the hospitals are located in adjacent areas, a pricing differential may arise between adjacent and non-adjacent transactions.</strong></p> <h2>Ability to Replace Hospitals Discounted</h2> <p>DH&L鈥檚 theory does not address some other implications of health plans鈥� ability to substitute hospitals in local geographic markets prior to a cross-market merger. The cross-market theory does not require any individual hospital to possess market power in its local hospital market prior to the merger in order for a cross-market merger to create market power. The extent to which there are substitutes within each market is, by construction, irrelevant to the cross-market effect. Rather, the theory predicts competitive danger arising from merging hospitals that, through cross-market linkages, gain incremental market power over customers who purchase in multiple markets simultaneously. <strong>Yet if a health plan could replace the individual hospitals in its network for each market in the pre-merger world, it stands to reason that it could replace the merged hospitals in each market just as readily. In that context, the merged hospitals could not acquire market power due to cross-market effects.</strong><sup><a href="#fn13">13</a></sup> If the merged entity creates efficiencies that are beneficial to the payor, it would be more costly to replace the merged entity than to replace each individual hospital, but that would not lead to antitrust harm.</p> <p>In a similar vein, cross-market employers can avoid competitive harm if they can act like single-market purchasers.<sup><a href="#fn14">14</a></sup> Notably, purchasers that do not require hospital services in both markets simultaneously (i.e., single-market health plans or employers) are not subject to the exercise of whatever market power is created by a cross-market merger. There are no cross-market linkages for these purchasers that could be exploited by the merged hospitals. Health plans could act like single-market purchasers if they sold separate products with local networks for each local market. Employers with employees in each market could offer single-market options to each set of employees. As long as employers acquire health insurance through a health plan rather than purchasing services directly from the hospital system, the system would not be able to identify cross-market employers and price discriminate against them. If the hospital system attempted to raise rates above competitive levels in each local market, it would lose customers in the traditional way: customers would switch to lower-cost substitutes in the local markets.</p> <h2>Improvements in Quality, Capital Investments and Value of System Membership Not Accounted For</h2> <p>DH&L鈥檚 empirical analysis also relies on some assumptions that may bias the findings. One source of upward bias in the price estimates may arise from capital investments and quality improvements at the acquired hospitals. It is common for systems to invest significantly to improve quality at newly acquired hospitals. In the Scranton, Pennsylvania area, for example, Geisinger Health System and Community Health System reportedly invested hundreds of millions of dollars in their newly acquired hospitals which has resulted in increased quality and access to care.<sup><a href="#fn15">15</a></sup> If systems tend to initiate these types of improvements at hospitals in adjacent markets before those in non-adjacent markets, possibly due to economies of scale and scope, pricing changes may be higher for hospitals in adjacent areas relative to those in non-adjacent areas. (Both Geisinger and CHS have hospitals in adjacent markets in Pennsylvania.) Importantly, DH&L find that prices rise in non-adjacent markets as well after a time delay, and the difference between adjacent and non-adjacent price increases is not statistically significant.</p> <p>Other factors may also drive differential pricing at newly acquired hospitals, as DH&L recognize. Among these other unobservable factors are increased bargaining skill attributable to system-wide sharing of the cost of a more expensive and skillful contract negotiating team or by pooling information from a larger set of contract negotiations.<sup><a href="#fn16">16</a></sup> Tenet Healthcare explains its use of new technology and a standardized negotiating format to improve its system results, outcomes that would not be available to non-system hospitals.<sup><a href="#fn17">17</a></sup> Among other possible factors is the entrepreneurial talents of some hospital managers that leads them to not seek merger partners or rate increases from insurers></p> <p><strong>Changes in pricing of this nature are not driven by increases in market power, but rather by dynamics that arise due to membership in a system.</strong> DH&L attempt to control for these system-wide changes by comparing different price effects at system acquisitions in adjacent and non-adjacent markets. They believe that nearby hospitals will be more likely to increase prices because they are more likely to have common customers. However, they also find comparable price increases in adjacent and non-adjacent markets, which is consistent with system-wide factors that do not affect competition.<sup><a href="#fn18">18</a></sup></p> <h2>Highly Aggregated Data Obscure Potentially Important Differences Across Plans</h2> <p><strong>The price estimation conducted by DH&L also relies on assumptions that affect the validity of their data. One of those is that they do not analyze actual negotiated transaction prices between health plans and hospital systems.</strong> Rather, they approximate prices based on total revenue, exclusive of Medicare payments but not omitting Medicaid revenue, with multiple adjustments to make the observations consistent.<sup><a href="#fn19">19</a></sup> It is not clear how this approximation affects their results. One possibility that cannot be divined from the data is whether health plans or employers are affected differently with some experiencing the estimated price increases while others do not. The highly aggregated data obscures any such price differences among payors.</p> <h2>Conclusion</h2> <p>The theories underlying concerns about cross-market effects are just coming into existence. There is little doubt that they will be the focus of continued academic research. The FTC has yet to employ a cross-market effects model in challenging a hospital merger in court, but it has begun to raise the question in its investigations. Although the courts have been unreceptive to cross-market merger theories, more such inquiries by the FTC are certain to be on the horizon.</p> <hr /> <ol> <li id="fn1">David A. Argue, Ph.D. and Lona Fowdur, Ph.D. are with Economists Incorporated in Washington, D.C. Dr. Argue co-authored a more detailed treatment of this subject in <em>Antitrust,</em> Vol. 30, No. 1, Fall 2015, published by the American Bar Association.</li> <li id="fn2"><em>See</em> U.S. Dep鈥檛 of Justice & Fed. Trade Comm鈥檔 Horizontal Merger Guidelines (2010) [hereinafter Guidelines], <a href="https://www.ftc.gov/sites/default/files/attachments/merger-review/100819hmg.pdf" target="_blank">https://www.ftc.gov/sites/default/files/attachments/merger-review/100819hmg.pdf</a>. This approach relies on the definition of a geographic market, the calculation of market shares and HHIs, and a determination based on those figures, as well as other market evidence, whether a transaction is likely to increase the combined entities鈥� market power and therefore substantially lessen competition within the defined geographic markets. Generally, courts have also accepted this approach.</li> <li id="fn3">Dafny, Leemore, Kate Ho, and Robin S. Lee, <em>The Price Effects of Cross-Market Hospital Mergers,</em> No. w22106. National Bureau of Economic Research (2016) [hereinafter DH&L].</li> <li id="fn4">DH&L, note 4.</li> <li id="fn5">More specifically, insurers will suffer a greater loss of profits when both hospitals are excluded from its network than the sum of the lost profits when each hospital is excluded individually. DH&L, pp. 3, 10.</li> <li id="fn6">DH&L, p. 26. DH&L explain that the Common Insurer effect arises when the merger allows the system to bypass a pricing limitation in one market by charging a higher price in the other market where pricing constraints do not apply. They also theorize that the Common Insurer effect may arise if customers have different elasticities of demand across the two markets which may allow the system to increase price in one market and lower it in another.</li> <li id="fn7">DH&L, p. 25.</li> <li id="fn8">DH&L rely on a sample of hospital mergers consummated between 1997 and 2011 that were investigated by the FTC and a separate sample of other hospital mergers.</li> <li id="fn9">DH&L, p. 2.</li> <li id="fn10">FTC v. St. Luke鈥檚 Health Sys., No. 13-cv-00116, 2014 WL 407446 (D. Idaho Jan. 24, 2014), <em>aff鈥檇,</em> St. Alphonsus Med. Ctr. v. St. Luke鈥檚 Health Sys., 778 F.3d 775 (9th Cir. 2015).</li> <li id="fn11">DH&L, pp. 16, 18 and 24.</li> <li id="fn12"><em>See</em> DH&L, p. 14.</li> <li id="fn13">If instead one or both hospitals did not have good substitutes in their individual areas, it is possible that cross-market effects could arise, but conduct such as all-or-nothing contracting could be subject to challenge under tying or more traditional theories of leveraging market power and cross-market antitrust theories could be unnecessary.</li> <li id="fn14">DH&L note that a key requirement of the cross-market effects is the presence of at least one common customer who values having both of the system hospitals in their network. DH&L, p. 11.</li> <li id="fn15">Morgan-Besecker, Terry, 鈥淓xperts Say Consolidation of Hospitals Can Be Good and Bad for Consumers,鈥� The Times Tribune, March 13 (2016).</li> <li id="fn16">DH&L, p. 14.</li> <li id="fn17">Colias, M., 鈥淩eady to Rumble,鈥� <em>Hospitals & Health Networks,</em> January 2006, pp. 32-36.</li> <li id="fn18">DH&L, p. 25.</li> <li id="fn19">DH&L, p. 17.</li> </ol> </div> <div class="col-md-4"> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2021/05/An-Examination-of-New-Theories-on-the-Price-Effects-of-Cross-Market-Hospital-Mergers.docx" target="_blank" title="Click here to download the study as a Word document.">Download the Study</a></div> </div> </div> </div> Mon, 10 May 2021 14:23:55 -0500 Position Paper /position-paper/2020-07-20-federal-public-policy-and-legislative-solutions-improving-maternal-health <p>Maternal health is a top priority for the AHA and our member hospitals and health systems, and our initial efforts are aimed at eliminating maternal mortality and reducing severe morbidity. As hospitals work to improve health outcomes, we are redoubling our efforts to improve maternal health across the continuum of care and reaching out to community partners to aid in this important effort.</p><p>The causes of maternal mortality and morbidity are complex, including lack of consistent access to comprehensive care and persistent racial disparities in health and health care. To help improve maternal health, we support the federal public policy and legislative actions discussed below.</p> Mon, 20 Jul 2020 09:11:32 -0500 Position Paper /position-paper/2019-04-30-impact-medicare-x-choice-coverage-healthcare-use-and-hospitals <h2>Executive Summary</h2> <div> <h3>Key Findings</h3> <ul> <li>We used a micro-simulation model to estimate the effects of the Medicare-X Choice Act<sup>1</sup> on health insurance coverage and healthcare spending.  Medicare-X Choice would make a public health insurance plan fully available on the health exchanges beginning in 2024 and reimburse providers using Medicare rates.</li> <li>We project public plan enrollment of 40.7 million in 2024, with approximately 90 percent of enrollees coming from individuals currently insured on the non-group market or through employer-sponsored insurance (ESI).</li> <li>Of the 29.0 million currently uninsured, Medicare-X Choice would result in 5.5 million gaining coverage. By comparison, additional support of the Affordable Care Act would result in 9.1 million uninsured persons gaining coverage.</li> <li>Nationally, healthcare spending would be reduced by $1.2 trillion (7%) over the 10-year period from 2024 to 2033, with spending for hospital services being cut by $774 billion -accounting for almost two-thirds of the total spending reduction.</li> <li>The Medicare-X Choice reductions in healthcare spending and increases in coverage would be financed through reductions in provider payments, given that Medicare rates are significantly less than payments by commercial payers.</li> <li>Medicare-X Choice would compound financial stresses already faced by the nation鈥檚 hospitals, potentially impacting access to care and provider quality.  MedPAC estimates Medicare hospital margins will be -11 percent in 2018. Moreover, the Congressional Budget Office has projected that between 40 and 50 percent of hospitals could have negative margins by 2025 under current law.</li> <li>While Medicare-X Choice would increase insurance coverage, the gains are modest relative to what could likely be achieved through strengthening existing components of the Affordable Care Act.</li> </ul> </div> <p>Access to affordable health care coverage continues to be a major public concern. While many Americans have gained coverage since the enactment of the Affordable Care Act (ACA) through, for example, health insurance marketplaces and state Medicaid expansions, approximately 27 million non-elderly individuals living in the U.S. remained uninsured in 2017, up slightly from 2016.<sup>2</sup> In 2017, Members of the 115th Congress introduced eight legislative proposals to expand public health insurance coverage. Seven of the eight proposals would make Medicare or a Medicare-like public plan option available to a larger population than currently has access to Medicare or other public insurance. The other proposal (Medicare-for-All) would create a single-payer healthcare system.</p> <p>In this study, we model the effects of the Medicare-X Choice Act on coverage and healthcare spending. Although not as expansive as Medicare-for-All, Medicare-X Choice would allow any individual to voluntarily enroll in a public plan offered on each health exchange. As a result, the Medicare-X Choice public plan鈥檚 reach would be broader than Medicare 鈥渂uy-in鈥� proposals that only allow certain age groups (e.g., age 55-64) to purchase Medicare. Under Medicare X-Choice, the public plan would reimburse providers using Medicare rates, which are significantly less than commercial rates and, for hospitals, fall below the cost of providing care.<sup>3</sup> We assess the impact of Medicare-X Choice on coverage and healthcare spending by projecting the take-up of the new public plans among the uninsured and those with commercial health insurance.</p> <h4><strong>Methods</strong></h4> <p>We used the KNG Health Reform Model (KNG-HRM) to estimate individual and family insurance coverage decisions. The KNG-HRM is a microsimulation model that uses a parameterized utility function to determine individual insurance coverage choices. The model is based on data from the 2017 U.S. Census Bureau鈥檚 American Community Survey (ACS), which is a large national survey of households. In the model, individuals consider several coverage options, maximizing utility for their family or 鈥渉ealth insurance unit (HIU).鈥� For the non-group market and those uninsured at baseline, changes from the status quo policy trigger a dynamic, iterative process with HIUs selecting new coverage choices and premiums being recalculated until a new equilibrium is reached. For this study, we expanded the KNG-HRM to incorporate coverage decisions of individuals on employer-sponsored insurance (ESI). For individuals receiving coverage through their employer, we used baseline premiums for ESI (updated over time for cost inflation) and assumptions on employer-covered share of premiums to model the decision to stay on ESI or select an alternative coverage option. Each individual鈥檚 utility is a function of healthcare consumption; out-of-pocket spending including premiums, cost-sharing reduction (CSR) subsidies and tax credits; and variance in out-of-pocket spending (to capture the value of insurance to mitigate risk of unexpectedly high healthcare expenditures). We do not model competition among health plans and, instead, assume that the availability of plans would be unaffected by the introduction of a public plan on the exchanges.</p> <p>We estimated healthcare utilization based on an individual鈥檚 demographics and imputed health status, including general health, presence of select chronic conditions, physical function, and cost-sharing requirements. We convert healthcare utilization into total and out-of-pocket spending by multiplying use rates by prices. Commercial insurer prices were obtained from publicly-available data from the Health Care Cost Institute (HCCI). We developed comparable Medicare prices using studies from the Congressional Budget Office (CBO) and other sources that compare commercial provider payment rates to Medicare rates.</p> <h4><strong>Key Findings</strong></h4> <p>We find that national enrollment in the public plan would be 40.7 million in 2024 and would increase slightly to 42.3 million by 2033 (Table ES1). Under Medicare-X Choice, the number of uninsured and the commercially insured on the non-group market would fall by 5.5 and 12.6 million in 2024, respectively, while enrollment in employer-sponsored insurance would fall by 22.6 million. About ninety percent of the enrollment in the public plans would comprise individuals who were either covered under ESI or on a commercial non-group plan in the baseline. While most of the enrollment in the public plan comes from those previously with ESI, the public plan take-up rate is highest (67%) among those with commercial non-group insurance.</p> <p>We compare estimated reductions in the number of uninsured under Medicare-X Choice in 2024 to the impact of a fully-implemented ACA (Figure ES1). Specifically, we update estimates reported by the Urban Institute on insurance coverage in 2019 and the impact of Medicaid expansion in non-expansion states and insurance coverage policies in effect during the 2018 Open Enrollment Period (OEP) as compared to the 2017 OEP. <sup>4,5</sup> We used estimates directly from the Urban Institute studies but updated for projected population growth between 2019 and 2024. We find that a fully implemented ACA would result in a reduction of 9.1 million in the uninsured, while Medicare-X Choice would result in a reduction of 5.5 million.</p> <hr /> <ol> <li>S. 1970. 115th Congress. 2017. Accessed at <a href="https://www.congress.gov/115/bills/s1970/BILLS-115s1970is.pdf" target="_blank">https://www.congress.gov/115/bills/s1970/BILLS-115s1970is.pdf</a>.</li> <li>Key Facts about the Uninsured Population. Kaiser Family Foundation. Accessed at <a href="https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population" target="_blank">https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population</a>.</li> <li>June 2018 Data Book. Medicare Payment Advisory Commission. Chart 6-19. Accessed at <a href="https://bit.ly/2EMwQ2Y" target="_blank">https://bit.ly/2EMwQ2Y</a>.</li> <li>Buettgens M. The Implications of Medicaid Expansion in the Remaining States: 2018 Update. The Urban Institute. Accessed at <a href="https://urbn.is/2QnkqGg" target="_blank">https://urbn.is/2QnkqGg</a>.</li> <li>Blumberg LJ, Buettgens M, Wang R. Updated: The Potential Impact of Short-Term Limited-Duration Policies on Insurance Coverage, Premiums, and Federal Spending. The Urban Institute. Accessed at <a href="https://urbn.is/2G07k8E" target="_blank">https://urbn.is/2G07k8E</a>.</li> </ol> Tue, 30 Apr 2019 13:22:29 -0500 Position Paper /position-paper/2019-03-11-impact-medicare-x-choice-coverage-healthcare-use-and-hospitals <div class="container"> <div class="row"> <div class="col-md-8"> <p>The 黑料正能量 Association (AHA) and the Federation of 黑料正能量s (FAH) released a new report that details the impact that a Medicare public option proposal could have on the ability of hospitals and health systems to continue to provide access to high-quality care to their patients and communities. The study finds that such a proposal, which would create a government-run Medicare-like health plan on the individual exchange, could have a significant impact on patient access to care. The proposal would result in the largest ever cut to hospitals - nearly $800 billion - and be particularly disruptive to the employer-sponsored health insurance market. The study further finds these significant disruptions would result in only a modest decrease in the number of uninsured compared to how many people would gain coverage through leveraging the public/private framework that exists under current law. The report was prepared by KNG Health Consulting on behalf of the AHA and FAH. Specifically, the findings in the report show that the proposal could:</p> <ul> <li>Result in only a modest drop in the number of uninsured compared to the 9.1 million Americans that would gain insurance by fully implementing the existing public/private coverage framework.<br>  </li> <li>Lead to a significant disruption to the employer-sponsored insurance market, which provides coverage to more than 150 million Americans.<br>  </li> <li>Lead to a cut of nearly $800 billion for hospital-based services over a 10-year period from 2024-2033 while utilization (and therefore, costs) will grow as a result of increased coverage.<br>  </li> <li>Impact the ability of providers, many of which are already absorbing more than $200 billion in Medicare cuts, to continue to care for patients under new public plans.<br>  </li> <li>Stifle hospitals鈥� ability to keep pace with new life-sustaining advances in medicine, to continue to invest in new payment and delivery models and to manage rapidly escalating drug prices.<br>  </li> <li>Continue to put pressure on other commercial plan rates, further undermining coverage for Americans not on Medicare, as well as other unintended consequences. </li> </ul> <p>Read on to learn more about the impact of the Medicare-X Choice Act on coverage, health care use, and hospitals.</p> </div> <div class="col-md-4"> <div class="panel module-typeC"> <div class="panel-heading"> <h3 class="panel-title text-align-center"><a href="/system/files/2019-03/the-impact-of-medicare-X-choice-final-report-2019.pdf">The Impact of Medicare-X Choice on Coverage, Healthcare Use, and Hospitals</a></h3> <p><a href="/system/files/2019-03/the-impact-of-medicare-X-choice-final-report-2019.pdf"><img alt="Report Cover Image" data-entity-type="file" data-entity-uuid="9238267c-a7e4-4caa-a71d-4b8232dd6b54" src="/sites/default/files/inline-images/The%20Impact%20of%20Medicare-X%20Choice%20Final%20Report-cover-329_0.jpg" width="350" height="454"></a></p> </div> </div> </div> </div> </div> Mon, 11 Mar 2019 12:35:49 -0500 Position Paper